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Biomedical subjects

H Sandvik

Publications and source records attributed to H Sandvik.

At least 19 recordsLinked to original sources
PubMed1995

Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.

Adult↗
PubMed1995

Female urinary incontinence--consultation behaviour and patient experiences: an epidemiological survey in a Norwegian community.

The objective was to study explanatory factors for help-seeking among incontinent women, and what was the outcome of the treatment. A questionnaire was mailed to all 2366 women aged 20 or over in the rural community of Rissa, Norway. Women confirming incontinence gave information about duration, precipitating factors, frequency, amount of leakage, and impact. Questions about doctor consultation or planned consultation, treatment and results were included. Women with incontinence which had resolved without treatment were also recorded. A total of 77% answered the questionnaire. Twenty per cent of women with incontinence (n = 535) had consulted a doctor, 18% had planned to consult. Increasing age and duration, and urge/mixed type of incontinence were determinative factors for doctor consultation, while increasing severity and impact were determinative for planned consultation. Drugs, exercises, pads, and electrostimulation were all important treatment options: 21% were cured, 40% much better after treatment. Of all the women, 8% reported that they had been incontinent in the past, and only 18% of these had consulted a doctor.

Adult↗
PubMed1995

General practitioners' management of female urinary incontinence. Medical records do not reflect patients' recall.

OBJECTIVES: To investigate the prevailing management of female urinary incontinence by Norwegian general practitioners (GPs), and to compare information given by the patients with information in their medical records. DESIGN: Incontinent women who had received reimbursement for incontinence aids or drugs were identified by the local Insurance Offices, and a random sample was interviewed about what examinations and treatments they had received. Similar information was later collected from their GPs. SETTING: The Bergen area, Norway. SUBJECTS: Forty-eight GPs and 82 patients. MAIN OUTCOME MEASURES: Actions taken according to the patients and their medical records. Kappa statistics were used to evaluate the strength of agreement. RESULTS: The GPs had done a gynaecological examination in 54%, a leakage provocation test in 12%, and a urinalysis in 73% of the patients. Thirty-two per cent of the women had been instructed in pelvic floor exercises and 13% in bladder training. The GPs had prescribed oestrogens for 48% of the older women (> 59 years), anticholinergics for 29% of those with urge or mixed incontinence. Overall Kappa between the two data sources was 0.37. CONCLUSION: GPs' incontinence management can be improved, especially regarding gynaecological examination, pelvic floor exercises, and the prescription of oestrogens. Retrospective chart data or patient interviews are unreliable data sources.

Adult↗
PubMed1995

Criterion validity of responses to patient vignettes: an analysis based on management of female urinary incontinence.

BACKGROUND AND OBJECTIVES: Patient vignettes are often used for investigating the performance of physicians. The purpose of this study was to assess the criterion validity of vignettes. METHODS: A random sample of incontinent women were interviewed, and vignettes depicting their cases were later presented to their own physicians. Questionnaires sent to the physicians included open questions about what drug treatment the doctor would give and a checklist (cueing items) for indicating other possible actions. Analysis compared actions taken with vignette patients and actual actions taken with the real patients. RESULTS: Thirty-two general practitioners and 32 patients were included in the study. When cueing items were provided, the physicians claimed more actions with vignettes than were actually performed. Mean difference was 1.9 actions per case (95% confidence interval 1.3 to 2.4). No such difference was found for the open question. When cues were provided, the likelihood ratio for reporting a vignette action in comparison with actually performing the action with a similar real patient was 2.8 (2.2 to 3.5), and Kappa .39. When no cues were provided, the likelihood ratio was 5.1 (2.6 to 10), and Kappa .45. Total number of actions with vignettes and real patients correlated significantly (r = .65, P < .001). CONCLUSIONS: Responses to vignettes with cueing items overestimate real performance. The agreement may be better when no cues are offered. The method may have acceptable validity for group comparisons.

Adult↗
PubMed1994

[Does garlic protect against vampires? An experimental study].

Vampires are feared everywhere, but the Balkan region has been especially haunted. Garlic has been regarded as an effective prophylactic against vampires. We wanted to explore this alleged effect experimentally. Owing to the lack of vampires, we used leeches instead. In strictly standardized research surroundings, the leeches were to attach themselves to either a hand smeared with garlic or to a clean hand. The garlic-smeared hand was preferred in two out of three cases (95% confidence interval 50.4% to 80.4%). When they preferred the garlic the leeches used only 14.9 seconds to attach themselves, compared with 44.9 seconds when going to the non-garlic hand (p < 0.05). The traditional belief that garlic has prophylactic properties is probably wrong. The reverse may in fact be true. This study indicates that garlic possibly attracts vampires. Therefore to avoid a Balkan-like development in Norway, restrictions on the use of garlic should be considered.

Animals↗
PubMed1994

[Roboratio or relaxatio? Clinical theory and practice in the 19th century].

The first Norwegian medical school was founded in 1814. Niels Berner Sørenssen (1774-1857), one of three professors, was responsible for teaching pathology and therapy, and for clinical education. Together with his student and successor, Andreas Christian Conradi (1809-68), he made his mark on Norwegian physicians for a period of 50 years. A few years ago a small handwritten book by a medical student, dated 1828, turned up in a second-hand market. This book, which contains notes from Professor Sørenssen's lectures on therapy, demonstrates that his teaching was heavily influenced by the speculative theories of John Brown (1735-88). Similar influence is traceable in the annual reports from Norwegian physicians during the second half of the 19th century. Sørenssen urged his students to thoroughly investigate the medical history and make a detailed clinical examination, and his attitude to therapy was careful, almost reluctant. This personal clinical attitude was probably more important than the theoretical foundation upon which he based his lectures.

Curriculum↗
PubMed1993

["Wise Men confound the World!". A district physician's struggle against superstition and sorcery in the 19th century].

When Michael Krohn (1822-97) was appointed district physician in Ytre Nordhordland in 1855 he had to fight hard against local witchcraft. Health education became his main strategy. He gave a series of lectures to the local Board of Health and also invited the schoolteachers to the meetings. The prejudiced local politicians neglected the school system and actively opposed the propositions he put forward. Nevertheless, a generation later the witches had disappeared. Health education can take some credit for this result, but probably the most important factor was simple trust.

Health Education↗
PubMed1993

Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey.

STUDY OBJECTIVE: The aim was to validate a simple severity index of female urinary incontinence for subsequent use in an epidemiological survey. DESIGN: The index was created by multiplying the reported frequency (four levels) by the amount of leakage (two levels). The resulting index value (1-8) was further categorised into slight (1-2), moderate (3-4), and severe (6-8). It was validated against a 48 hour "pad weighing" test. Thereafter, an anonymous postal questionnaire survey was performed and the index was used to assess the severity of the leakage. A question about the impact of incontinence was also included. SETTING: The outpatient clinic of the Department of Gynaecology and Obstetrics, Trondheim University Hospital and the rural community of Rissa, Norway. PARTICIPANTS: Altogether 116 incontinent women referred to the clinic by their GP and all 2366 adult women living in Rissa. RESULTS: The difference in median pad weights between moderate and slight incontinence was 9g/24h (95% confidence interval 0-27). The corresponding difference between severe and moderate incontinence was 17g/24h (95% CI 5-30). In the epidemiological survey 29.4% reported urinary incontinence (response rate 77%). The prevalence tended to be highest in middle life and old age. Forty six per cent were classified as slight, 27% moderate, and 27% severe. There was a strong correlation between severity and impact (R = 0.59, p < 0.001). CONCLUSION: The severity index may be a useful tool for assessing the severity of female urinary incontinence in epidemiological surveys. It is confirmed that urinary incontinence is very prevalent in adult women, but most should not be regarded as potential patients.

Adult↗
PubMed1993

One hundred and fifty men with urinary incontinence. III. Psychosocial consequences.

OBJECTIVE: To investigate the psychosocial impact of urinary incontinence among men. DESIGN: Telephone interviews with men who had give their written consent to participate. SUBJECTS: 150 men were available for interviews out of 571 who had asked for information about urinary incontinence and free samples of pads by post. MAIN OUTCOME MEASURES: Questionnaire which mapped demographic data, occupational status, medical history, medication, and toilet habits. Duration, frequency, and amount of leakage were registered, and the incontinence was classified according to a symptom questionnaire. Consultations and other sources of help were also registered, together with use of control methods, emotional, practical, and social consequences. RESULTS: Twenty-four per cent stated that their incontinence was a negligible problem. Generally, increasing severity of the incontinence caused more mental distress and social restrictions. Younger men were more handicapped than the older men. Practical inconveniences and social restrictions increased with longer duration of the incontinence. A multiple regression analysis, using a severity index, duration, type, and age as explanatory variables for the degree of mental distress, practical inconveniences, and social restrictions could explain 7%, 12%, and 25% of the variation in these groups of consequences, respectively. CONCLUSION: Urinary incontinence is associated with negative psychosocial effects, the impact increasing with the severity of the incontinence and decreasing with age of the incontinent men.

Age Factors↗
PubMed1992

[Leprosy and heredity. Reflections of a district physician in 1884].

During the 19th century leprosy was a serious health problem in Norway, especially in some western, rural districts. In 1856 it was decided that all leprous patients should be examined by the local doctor (District Health Officer), and registered in a national leprosy register. The patients' family relationships received special attention. Some patients tried to avoid registration, fearing that the data might be misused. After Armauer Hansen (1841-1912) discovered in 1873 that leprosy was an infectious disease, isolation of leprous patients was enforced. In 1884 Thomas Collett (1835-1898), the local doctor in a rural district of western Norway, carried out a survey of all leprous patients registered in his district, a total of 164 patients. The data from his survey provide convincing support for the view that hereditary factors play an important role in the development of the disease. Modern research has confirmed that an important gene controls the susceptibility to leprosy.

History, 19th Century↗
PubMed1992

[No connection between scarlet fever and gouty fever. Historical analysis from Ytre Nordhordland during 1862-1884].

In 1987 there was an unexplained increase in severe streptococcal diseases in Norway and other western countries. In Norway this increase was not accompanied by a corresponding increase in acute rheumatic fever. This study investigated the occurrence of scarlet fever and acute rheumatic fever in a rural district (approximately 15,000 inhabitants) of western Norway during the years 1862-1884. Four epidemics of severe scarlet fever occurred during this period. The local doctor treated 1,155 patients (96% children), of whom 154 (13.3%) died. Acute glomerulonephritis with subsequent kidney failure seems to have been a major cause of death. During the same period 76 patients (96% adults) were treated for acute rheumatic fever. These cases were not related to the severe epidemics of scarlet fever. It is probable that different, co-circulating strains of streptococci caused the infections, which were followed by glomerulonephritis and rheumatic fever. It is possible that rheumatic fever was caused by the strain that induced the more benign "Angina tonsillaris".

Disease Outbreaks↗
PubMed1991

[Study and treatment of urinary incontinence in women. A case load based study by general practitioners and gynecologists].

139 general practitioners and 190 gynaecologists responded to a case-history questionnaire about female urinary incontinence. More gynaecologists than general practitioners reported more frequent use of leakage provocation test, neurological examination, frequency-volume chart, and measurement of residual urine. Among the less relevant procedures, use of blood tests was reported more frequently by general practitioners, and use of x-rays and ultrasonography by gynaecologists. General practitioners preferred urine microscopy to urine culture. The opposite was true for the gynaecologists. 50% of the gynaecologists would prescribe oestrogens for the postmenopausal women, as against 25% of the general practitioners. Young women were instructed in pelvic floor exercises, incontinence pads were prescribed for elderly women.

Adult↗
PubMed1990

[Psychiatric patients in private care. Historical analysis from a municipality in western Norway].

Radøy, an island (4,500 inhabitants) in Western Norway, has traditionally accepted many psychiatric patients for care in foster homes. Since the end of the 19th century, 855 patients placed in foster homes have been registered. Only 7% of these were original inhabitants of Radøy. The mean duration of stay was 13 years (median: 9). The tendency has been towards longer periods of stay, older patients, an increasing number of female patients, and more schizophrenic patients. It takes on average nine months (median: 5) after cancellation of the foster contract before the patient receives alternative accommodation. The waiting period for a place in a nursing home is especially long. This problem must be solved if care in a foster home is to be a suitable alternative in the future.

Female↗
PubMed1990

Management of urinary incontinence in gynecological practice in Norway.

In order to investigate how Norwegian gynecologists manage female urinary incontinence in their daily practice, a questionnaire about six typical case histories was sent to the members of the Norwegian Gynaecological Association. The questionnaire comprised questions about investigations, use of laboratory tests and treatment options. Of 268 questionnaires sent out, 190 were returned (71%). Frequency-volume charts were recommended by 42% of the doctors and pad-weighting tests by 12%. Urodynamic examination was recommended for 55% of the cases, but mainly in mixed incontinence (76 and 77%). Pelvic floor exercises were suggested more often to younger patients than to the elderly. Drugs were infrequently suggested, mainly following appropriate indications. Drugs and pads were recommended especially for the elderly. The recommendation rate for surgical repair was higher for young age and greater degree of stress incontinence. The modest therapeutic ambition on behalf of the elderly women lacks basis in clinical research. A general management program for female urinary incontinence would possibly standardize and improve the quality of incontinence care by gynecologists in Norway.

Adult↗